Provider Demographics
NPI:1104353085
Name:PEGGINS, JUSTINE (BCBA)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:
Last Name:PEGGINS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1773 ABERDEEN CIR
Mailing Address - Street 2:
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1635
Mailing Address - Country:US
Mailing Address - Phone:301-741-3456
Mailing Address - Fax:
Practice Address - Street 1:1773 ABERDEEN CIR
Practice Address - Street 2:
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1635
Practice Address - Country:US
Practice Address - Phone:301-741-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-22
Last Update Date:2025-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1-18-32823103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD92-3759390Medicaid